The 2009 C-Section rate in NJ was 40.0%, among the highest in the nation.
This is the website for the International Cesarean Awareness Network (ICAN) of Somerset County, NJ with special attention to the state of birth throughout New Jersey. ICAN of Somerset provides cesarean education, recovery support and vbac education. Email: ICANofSomerset@gmail.com for more information on cesarean prevention and vbac options in and near Somerset County NJ.
PLEASE CHECK OUT OUR NEW NJ ICAN WEBSITE AT: www.icanofnj.com

June 08, 2008

Planned c-section = greater risk of baby death

Voluntary C-Sections Result in More Baby Deaths

By NICHOLAS BAKALAR

A recent study of nearly six
million births has found that the risk of death to newborns delivered
by voluntary Caesarean section is much higher than previously believed.

Researchers have found that the neonatal mortality rate for
Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live
births, while the rate for vaginal delivery is 0.62 deaths per 1,000.
Their findings were published in this month’s issue of Birth: Issues in Perinatal Care.

The percentage of Caesarean births in the United States increased to
29.1 percent in 2004 from 20.7 percent in 1996, according to background
information in the report.

Mortality in Caesarean deliveries has consistently been about 1½
times that of vaginal delivery, but it had been assumed that the
difference was due to the higher risk profile of mothers who undergo
the operation.

This study, according to the authors, is the first to examine the
risk of Caesarean delivery among low-risk mothers who have no known
medical reason for the operation.

Congenital malformations were the leading cause of neonatal death
regardless of the type of delivery. But the risk in first Caesarean
deliveries persisted even when deaths from congenital malformation were
excluded from the calculation.

Intrauterine hypoxia — lack of oxygen — can be both a reason for
performing a Caesarean section and a cause of death, but even
eliminating those deaths left a neonatal mortality rate for Caesarean
deliveries in the cases studied at more than twice that for vaginal
births.

“Neonatal deaths are rare for low-risk women — on the order of about
one death per 1,000 live births — but even after we adjusted for
socioeconomic and medical risk factors, the difference persisted,” said
Marian F. MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study.

“This is nothing to get people really alarmed, but it is of concern
given that we’re seeing a rapid increase in Caesarean births to women
with no risks,” Dr. MacDorman said.

Part of the reason for the increased mortality may be that labor,
unpleasant as it sometimes is for the mother, is beneficial to the baby
in releasing hormones
that promote healthy lung function. The physical compression of the
baby during labor is also useful in removing fluid from the lungs and
helping the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like
possible cuts to the baby during the operation or delayed establishment
of breast-feeding, may also contribute to the increased death rate.

The study included 5,762,037 live births and 11,897 infant deaths in
the United States from 1998 through 2001, a sample large enough to draw
statistically significant conclusions even though neonatal death is a
rare event.

There were 311,927 Caesarean deliveries among low-risk women in the analysis.

The authors acknowledge that the study has certain limitations,
including concerns about the accuracy of medical information reported
on birth certificates.

That data is highly reliable for information like method of delivery
and birth weight, but may underreport individual medical risk factors.

It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said.

Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics
at the University of Texas Medical Branch at Galveston, said that
doctors might want to consider these findings in advising their
patients.

“Despite attempts to control for a number of factors that might have
accounted for a greater risk in mortality associated with C-sections,
we continued to observe enough risk to prompt concern,” he said.

“When obstetricians review this information, perhaps it will promote
greater discussion within the obstetrical community about the pros and
cons of offering C-sections for convenience and promote more research
into understanding why this increased risk persists.”